Emotional symptoms and sensation seeking: Implications for tobacco interventions for youth and young adults.

Introduction: Although emotional symptoms and sensation seeking are recognized as important risk factors for tobacco use among youth and young adults, to date, their joint influence on tobacco use has not been examined.

Methods: Data used in this study are from the Texas Adolescent Tobacco and Marketing Surveillance study, a population-based cohort. At baseline, in 2014, participants were in the 10th grade. Mixed-effects logistic regression models examined associations between emotional symptoms and sensation seeking in 2014 and odds of past 30-day cigarette and e-cigarette use in 2018. Interactions between emotional symptoms and sensation seeking were examined to assess whether one modifies the effect of the other on cigarette and e-cigarette use.

Results: After adjusting for age, sex, race/ethnicity, school type, and ever use of cigarettes or e-cigarettes at baseline, adolescents with high emotional symptoms (AOR=1.97; 95% CI:1.07-3.60, and AOR=1.68; 95% CI: 1.06-2.66) and with high sensation seeking tendencies (AOR=2.05; 95% CI: 1.03-4.10, and AOR=1.68; 95% CI: 1.02-2.76) had significantly higher odds of past 30-day cigarette and e-cigarette use four years later compared to adolescents with low emotional symptoms and low sensation seeking tendencies. The interaction was significant (p=0.01) for e-cigarette use only; among low sensation seekers, adolescents who reported high levels of emotional symptoms were at increased risk for past 30-day use (AOR=3.43; 95% CI: 1.38-8.51), and among adolescents with low emotional symptoms, high sensation seekers were at increased for risk for past 30-day use (AOR=3.50; 95% CI: 1.54-7.91).

Conclusions: It is important for tobacco use prevention programs to consider both behavioral risk factors - sensation seeking and emotional symptoms - in an integrative way, to target high risk subgroups and thereby increase the efficacy of existing effective intervention strategies in order to curb tobacco use among youth and young adults.